NCLEX-RN cheat sheet · Neurologic
Seizures and spinal cord injury
Seizure types, care during and after, status epilepticus, antiseizure drugs, EEG, injury levels, autonomic dysreflexia
AI-checkedChecked by AI against current guidelines, with spot-checks by a registered nurse.
In a seizure, keep the client safe, time it, and know when it's an emergency. In a spinal cord injury, where the damage happens decides what the client loses.
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At a glance
Seizure types
| Type | What happens |
|---|---|
| Focal aware | Once called simple partial. The client stays aware, often after an aura, like deja vu or a strange smell |
| Focal impaired awareness | Once called complex partial. Repeated movements; the client is unaware, may wander, and won't remember it |
| Tonic-clonic | Body stiffens, consciousness is lost, then rhythmic jerking; may bite the tongue or lose bladder or bowel control. Convulsions still going at 5 minutes need emergency treatment |
| Myoclonic | Brief jerks of the arms or legs |
| Atonic | Muscle tone suddenly drops; the client often falls |
Phases, epilepsy, causes: Phases: early warning changes, the aura, the seizure, then the postictal recovery period. Epilepsy: two unprovoked or reflex seizures more than 24 hours apart, or one with a 10-year recurrence risk of 60% or more, or an epilepsy syndrome. Causes: most have no known cause; tumors, high fever, low sodium, low glucose, alcohol withdrawal, stroke and infections can trigger them.
During a seizure
- Ease the client to the floor. In bed: remove extra pillows and raise the side rails.
- Cushion the head, loosen clothing, remove glasses, move objects away.
- Don't restrain the client or try to stop the movements.
- Time the start and the end.
- Never put anything in the mouth or pry the jaw open.
- Watch the aura, eyes and pupils, consciousness, breathing, color, drooling, incontinence. Stay with the client and call for help.
After a seizure
- Turn the client on their side to prevent aspiration; keep the airway open.
- Check vital signs and neuro signs; let the client rest.
- Confusion is common: keep the area safe and reorient calmly.
- Watch for more seizures, and for pauses in breathing, right after a generalized seizure.
- Seizure precautions: oxygen and suction at the bedside, the bed low, padded rails per policy.
Status epilepticus
- A seizure lasting 5 minutes or more, or seizures one after another without full recovery.
- It damages neurons and is unlikely to stop on its own: an emergency.
- Call for help, give oxygen per policy, expect lorazepam, diazepam or midazolam. Without IV access, IM midazolam is a first-line option.
- These drugs can depress breathing: watch the heart, breathing and oxygen saturation closely.
EEG
- Records the brain's electrical activity through scalp electrodes. Explain it's painless, with no shock.
- Before: wash the hair, with no conditioner, creams or gels.
- Avoid caffeine and fasting, which change the results. Ask the provider which drugs to hold.
- After: restart any held drugs, and wash out the electrode paste.
Antiseizure drugs
| Drug | Watch for and teach |
|---|---|
| After a first seizure | Drugs usually aren't started, but it needs prompt assessment, and a specialist within 2 weeks. Never wait out emergency signs |
| All | Control seizures but don't cure epilepsy. Never stop them suddenly: seizures or status epilepticus can follow. Watch mood: they can bring suicidal thoughts |
| Phenytoin | Total level 10 to 20 mcg/mL; free levels differ. IV slowly, with heart monitoring. Gum overgrowth, jerky eye movements, unsteadiness. A new rash: hold the dose and notify the provider at once; the prescriber decides whether to stop it |
| Carbamazepine, lamotrigine | Severe skin reactions |
| Valproate | Can harm the liver and a developing baby |
Teach: What to do about a missed dose; check before any over-the-counter drug; wear a medical alert ID; keep a seizure diary; follow state driving laws; avoid alcohol and getting overtired. Make sure the family knows how to respond, and when to call emergency services.
Spinal cord injury: level and function
| Level | What's affected |
|---|---|
| High cervical (C1-C4) | Breathing can stop: those nerves move the diaphragm |
| Cervical | Arms, legs and trunk: tetraplegia |
| Thoracic | Legs: paraplegia |
| Lumbar and sacral | Legs, bowel and bladder |
Complete or incomplete: Sacral sparing decides it: a complete injury keeps no feeling or movement at S4 to S5; an incomplete injury keeps some there. Neck and high chest injuries can also disturb blood pressure, sweating and temperature.
At the scene
- Move the client only when airway protection, CPR or danger requires it, keeping alignment with enough trained help.
- Hold head and neck as found; don't straighten, bend or twist.
- Don't let the person get up and walk; don't remove a helmet.
- If CPR is needed: keep the neck in line and open the airway with a jaw thrust. If that fails, the airway comes first.
- Vomiting: log-roll with enough trained help, keeping the head, neck and back in line.
Treatment and problems afterward
- Paralysis can appear at once, or later from bleeding and swelling. Relieving pressure early may help: time matters.
- Respiratory problems, often pneumonia, are the leading cause of death. Aspiration precautions help prevent it.
- Blood pressure swings, rhythm changes, leg clots: expect blood thinners and compression stockings.
- Reposition per the client's surface, skin and tolerance.
- Bladder and bowel: a catheter or a bowel program.
Autonomic dysreflexia: an emergency
- Who: classically an injury at T6 or above: the neck or upper back.
- Trigger: something below the injury, most often a full bladder or bowel, or tight clothing.
- Signs: a pounding headache; a sudden rise in blood pressure compared with the client's low baseline; slow heart rate; flushing, sweating.
- First: sit the client up, keeping the body aligned; call for help; loosen tight clothing; check the blood pressure urgently and repeatedly.
- Then: find and remove the trigger, bladder first, then the bowel; give ordered rapid antihypertensive treatment when indicated.
- Prevent: check and train the bladder and bowel; keep the bladder empty and the urine dilute; protect the skin.
Priority and safety calls
- ★ Tonic-clonic seizure in bed: raise the rails, remove pillows, time it. No tongue blade, no holding down, don't leave to get help.
- ★ A tonic-clonic seizure has lasted 6 minutes: status epilepticus. Call for emergency help.
- ★ T4 injury with a pounding headache, flushing and sweating: sit the client up first, get help, loosen clothing, recheck the pressure, then look for the trigger.
- Just admitted after a high cervical injury: breathing and airway come first.
How the NCLEX tests it
- During: protect, time it, don't restrain, and nothing in the mouth.
- Traps: something in the mouth, holding the client down, leaving to get help first, stopping drugs when seizure-free.
- Higher injuries affect more; the top four neck levels can stop breathing.
- Dysreflexia at T6 or above: sit up, get help, monitor the pressure, remove the trigger, treat as ordered.
- Traps: lying a dysreflexia client flat, or hunting for the cause before sitting them up.
Practice it next
This sheet comes from Seizures and epilepsy and Spinal cord injury in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- Status epilepticus is a seizure lasting ___ minutes or more.
Show answer
5 - After a seizure, turn the client on their ___.
Show answer
side - The total phenytoin range is 10 to ___ mcg/mL.
Show answer
20 - Before an EEG, avoid caffeine and ___.
Show answer
fasting - Sacral sparing at S4 to ___ decides complete or incomplete.
Show answer
S5 - In dysreflexia, check the ___ first for the trigger.
Show answer
bladder
Sources
- Open RN, Nursing: Health Alterations, 9.7 Seizures and Epilepsy
- Open RN, Nursing Pharmacology 2e, 8.10 Anticonvulsants
- American Epilepsy Society, Guideline for treatment of prolonged seizures
- Open RN, Nursing: Health Alterations, 9.12 Other Nervous System Disorders
- MedlinePlus, Spinal injury (first aid)
More neurologic cheat sheets
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.